Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series.

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Abstract

[Indexed for MEDLINE] 14. BMC Musculoskelet Disord. 2024 Apr 3;25(1):262. doi: 10.1186/s12891-024-07314-3. Surgical management of lower limb radiculopathy following acute singe-level osteoporotic vertebral fracture of lower lumbar spine in geriatric patient: a retrospective study. Zhang Y(#)(1), Lu Y(#)(1), Lin W(1), Yao M(1), Song J(2), Ding L(3). Author information: (1)Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China. (2)Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China. sjpfly@163.com. (3)Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China. dinglx@bjsjth.cn. (#)Contributed equally BACKGROUND: Radiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision. METHODS: We retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated. RESULTS: From September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P